Clinical InvestigationFactors of health in the protection against death and cardiovascular disease among adults with subclinical atherosclerosis
Section snippets
Study participants
MESA is a community-based cohort study of the prevalence, correlates, and progression of subclinical and clinical ASCVD. Details of the MESA study design and objectives are reported elsewhere.14 Briefly, 6,814 participants between the ages of 45 and 84 free of clinical ASCVD at baseline were enrolled between 2000 and 2002 (visit 1) at 6 US field centers (Baltimore, MD; Chicago, IL; Forsyth County, NC; Los Angeles, CA; New York, NY; and St Paul, MN). Four follow-up visits were conducted in 2002
Study cohort
The study population consisted of 1,601 MESA participants. The mean (±SD) age was 69 (±9) years, 64% were males, 49% were white, 22% African American, 18% Hispanic, and 10% Chinese. The median (IQR: 25th-75th percentile) baseline CAC was 332 (177-677) Agatston units. Baseline characteristics, overall and according to presence of incident hard ASCVD events during follow-up, are summarized in Table I. Compared with individuals who developed incident ASCVD events, those who remained free of ASCVD
Discussion
The current study demonstrates modifiable health factors that are associated with lower risk and delay in onset of ASCVD or death among individuals with subclinical atherosclerosis as determined by elevated CAC. Specifically, nonsmoking, adequate physical activity, absence of chronic stress, high HDL-C levels, and normoglycemia were inversely associated with risk of hard ASCVD events and/or death. There were also favorable trends for Mediterranean diet, emotional support, and absence of
Summary statement
The presence of high CAC does not predetermine the development of clinical CVD, and this analysis demonstrates that adults with subclinical atherosclerosis have behavioral and psychosocial options to improve their prognosis over and above standard preventive therapies such as aspirin and statins.
Conflict of interest statement
The authors report no conflicts of interest relevant to this work.
Acknowledgements
This research was supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute and grants UL1-TR-000040 and UL1-TR-001079 from the National Center for Research Resources. The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list
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Registration: ClinicalTrials.gov NCT00005487
Supplementary information is provided in an Online Appendix. Disclosures are provided in the submission documents.